What Causes Vomiting?

1. Symptoms of vomiting and fever should pay attention to acute infectious diseases; vomiting with unclean diet or collective onset of food should consider food or drug poisoning; vomiting with chest pain, common in acute myocardial infarction or acute Pulmonary infarction, etc .; Those with vomiting and abdominal pain are common in inflammation, obstruction and rupture of abdominal organs; Those with temporary relief after vomiting suggest peptic ulcer, acute gastritis and gastrointestinal obstructive diseases; Those with abdominal pain that cannot be relieved after vomiting , Common in biliary disorders, urinary disorders, acute pancreatitis, etc .; vomiting with headache, in addition to considering intracranial hypertension, migraine, rhinitis, glaucoma and refractive error should be considered; vomiting with dizziness, should be considered Vestibular and labyrinthic diseases, insufficient blood supply to the basal vertebral artery, insufficient blood supply to the posterior inferior cerebellum, and neurological damage caused by certain drugs (aminoglycoside antibiotics).

Nausea and vomiting

Nausea and vomiting is one of the most common symptoms in the clinic. Nausea is a special subjective sensation, manifested as upset stomach and fullness, often a prelude to vomiting, often accompanied by salivation and repeated swallowing movements; vomiting is a reflexive strong contraction of the stomach, which passes through the stomach and esophagus , Oral cavity, diaphragm muscle, and abdominal muscles and other parts of the synergistic effect, can force the stomach contents from the stomach, esophagus through the oral cavity quickly excreted from the body. Nausea and vomiting can be caused by a wide variety of diseases and pathophysiological mechanisms. The two may or may not accompany each other.

Nausea and vomiting signs and symptoms

2. Modes and characteristics of vomiting Jet vomiting is more common in intracranial pressure caused by intracranial inflammation, edema and bleeding, space-occupying lesions, and meningitis adhesion, usually without nausea. In addition, glaucoma and 8th pair of cerebral neuropathy may also exhibit jet vomiting. Vomiting is effortless and occurs immediately after meals. The amount of vomiting is small and is seen in mental vomiting.

Pay attention to the amount, properties and odor of vomit. Large amounts of vomiting and rotten food suggest pyloric obstruction with gastric retention, gastroparesis, and upper intestinal obstruction; vomiting is coffee-like or bloody and is seen in upper gastrointestinal bleeding; incompletely digested food indicates esophageal vomiting (cardiac Achalasia, esophageal divergence, esophageal cancer, etc.) and seen in neurogenic vomiting; those with bile are commonly found in frequent severe vomiting, duodenal or small intestinal obstruction below the duodenal papilla, cholecystitis, cholelithiasis, and stomach After major resection, it is sometimes seen in pregnancy with severe vomiting and motion sickness; those who have vomit sour odor or stomach contents have fecal odor suggesting low intestinal obstruction, paralytic intestinal obstruction, colon obstruction and the sacral valve is closed. Incomplete or gastrocolonic fistula.

3. Time-related relationship between vomiting and eating. Vomiting during eating or early after eating is common in pyloric ulcer or mental vomiting; vomiting late in meals or after several meals is seen in pyloric obstruction, intestinal obstruction, gastroparesis or superior mesenteric artery Compression causes duodenal accumulation; morning vomiting is more common in pregnant vomiting, and sometimes also in uremia, chronic alcoholism, and intracranial hypertension.

Nausea and vomiting medication

Because there are many diseases that cause nausea and vomiting, nausea and vomiting are only one of the symptoms of the disease. Therefore, strong antiemetic drugs acting on the center of vomiting should not be applied blindly before the cause is clear, otherwise the disease will be affected. Only after the cause of vomiting is identified, the necessary symptomatic treatment can be performed on the basis of active treatment of the cause.

1. Gastrointestinal diseases include esophagus, stomach, duodenum to jejunum, ileum, colon and rectum. Any pathological changes may cause nausea and vomiting. Among them, esophageal stricture, esophageal cancer, and cardia loss Flaccid, cardia cancer, eosinophilic granuloma of the gastric antrum, large ulcer or cancer of the gastric antrum, duodenal ulcer or stagnation, small intestine and large intestine obstruction due to multiple reasons or acute gastric, small or large intestinal inflammation Lesions are the most common cause. Vomiting due to narrowing or obstruction caused by benign or malignant gastrointestinal tract, drug treatment is ineffective. The symptoms of vomiting will only disappear after dilatation, stent placement or surgical treatment to relieve stenosis or obstruction. For patients with achalasia, prior to dilatation or surgery, calcium channel antagonists or nitroglycerin can be taken orally half an hour before meals or sublingually for 15 to 30 minutes before meals, which can improve symptoms of vomiting and obstruction at an early stage; Or try botulinum toxin for local narrow injection. For vomiting caused by acute inflammatory lesions of the gastrointestinal tract, you should actively choose antibiotics and correct electrolyte disturbances and supplement vitamins; nausea and vomiting caused by gastrointestinal motility disorders can use mosapride and other gastrointestinal motility agents; if vomiting is caused by Caused by gastrointestinal spasm, anticholinergic drugs such as scopolamine can be applied.

2. Liver, biliary and pancreatic diseases are one of the common causes of nausea and vomiting. Nausea and vomiting are early symptoms of acute viral hepatitis. They often occur at the same time as loss of appetite, greasy food, and fullness in the upper abdomen. After liver treatment and proper rest, nausea and vomiting can gradually disappear. Vomiting is also a symptom often accompanied by biliary obstruction or colic. Vomiting will stop only when the biliary obstruction or inflammation is eliminated. Acute pancreatitis is often accompanied by nausea and vomiting. Only with the use of gastrointestinal decompression reduces pancreatic juice and pancreas. After measures such as the secretion of enzymes, vomiting will gradually ease or stop.

3. Central nervous system lesions Including encephalitis, meningitis, brain tumors, cerebral parasitic diseases, cerebrovascular diseases, and craniocerebral trauma caused by various reasons, can cause increased intracranial pressure and cause nausea and vomiting. One of the important treatment measures is the application of medications that reduce intracranial hypertension and reduce brain cell edema. Dehydration treatment can not only improve the symptoms of vomiting, but also play a role in protecting or restoring brain cell function.

4. Drug-induced vomiting Many drugs have adverse reactions that cause nausea and vomiting. In general, as long as the application of the drug that causes vomiting is stopped immediately, the symptoms of vomiting will be reduced until it disappears, so it is not necessary to apply antiemetic drugs. At present, combined chemotherapy or radiotherapy is often used for certain malignant tumors or hematological malignancies (such as leukemia, malignant lymphoma, multiple myeloma, malignant histiocytosis, etc.), or anticancer drugs are used for certain malignant tumors. Interventional treatment. However, during or after treatment, it can cause serious gastrointestinal adverse reactions, the most prominent manifestations of which are nausea and vomiting. In order to prevent or alleviate this adverse reaction, antiemetic drugs can often be used for treatment. The commonly used drugs are ondansetron (ondansetron) (commodity name: Zhufuning), granisetron (brand name: Kangquan) And Ondan Sejong. It must be pointed out that after the application of these powerful antiemetic drugs, adverse reactions of the central nervous system, cardiovascular system or gastrointestinal tract will also occur, so the dose and interval of the drugs should be strictly controlled.

5. Vomiting due to nerve and mental factors Psychotherapy is the key to vomiting due to such causes. First, the patient's mental and psychological disorders should be eliminated, and secondly, it can be combined with drug treatment. The commonly used drugs are sedatives and gastrointestinal prokinetic agents. In severe cases, antidepressants such as doxepin or fluoxetine can be used for treatment. It is contraindicated to use strong antiemetics such as ondansetron (Ondansetron).

Nausea and Vomiting Diet Care

1, mostly light food, pay attention to diet rules.

2. Eat a reasonable diet based on your doctor's recommendations.

3, the disease does not have much contraindications to diet, diet can be reasonable.

Nausea and vomiting preventive care

There is no effective preventive measure for this disease. Early detection and early diagnosis are the key to the prevention and treatment of this disease.

Causes of Nausea and Vomiting

The causes of nausea and vomiting are wide-ranging, including many factors, involving almost every system.

1. Infections Viral acute gastroenteritis, bacterial acute gastroenteritis, acute viral hepatitis, etc., appendicitis, cholecystitis, peritonitis, acute fallopian tubes, pelvic inflammatory disease, etc.

2. Other abdominal diseases

(1) Organ pain: pancreatitis, cholelithiasis, kidney stones, intestinal ischemia, ovarian cyst pedicle twisting.

(2) Gastrointestinal obstruction: pyloric obstruction (ulcer disease, gastric cancer, extraluminal mass compression), duodenal obstruction (duodenal cancer, pancreatic cancer), intestinal adhesions, intussusception, strangulated hernia, Crohn's disease, intestinal tuberculosis, intestinal tumors, intestinal roundworm, intestinal torsion, superior mesenteric artery compression syndrome, export diaphragmatic syndrome, gastrointestinal motility disorder (diabetic gastroparesis, non-diabetic gastroparesis), pseudointestine Obstruction (connective tissue disease, diabetic enteropathy, tumor enteropathy, amyloidosis, etc.).

3. Endocrine and metabolic diseases Hyponatremia, metabolic acidosis, malnutrition, vitamin deficiency, diabetic acidosis, hyperthyroidism, hypothyroidism, hyperparathyroidism, hypopituitarism, hypoadrenal function, A variety of endocrine crisis, uremia and so on.

4. Nervous system diseases: Central nervous system infection (encephalitis, meningitis), brain tumors, insufficient blood supply to the brain, cerebral hemorrhage, traumatic brain injury, cerebral parasitic disease, etc.

5. Physicochemical factors such as drugs Anesthetics, digitalis, chemotherapy drugs, antibiotics, dopamine receptor agonists, non-steroidal anti-inflammatory drugs, theophylline, alcohol, radiation, etc.

6. Psychic vomiting, polyphagia, anorexia nervosa.

7. Vestibular diseases Motion sickness, Meniere's disease, and inner ear labyrinthitis.

8. Pregnancy vomiting, severe vomiting during pregnancy, acute fatty liver during pregnancy.

9. Other cardiopulmonary disorders (myocardial infarction, pulmonary infarction, hypertension, acute pulmonary infection, pulmonary heart disease), urological disorders (acute nephritis, acute pyelonephritis, uremia), periodic vomiting, postoperative nausea and vomiting, glaucoma, etc. .

Diagnosis of nausea and vomiting

1. Acute infections There are many causes of acute gastroenteritis, including bacterial infections, viral infections, chemical and physical stimuli, allergic factors and stress factors. Among them, acute non-typhoid Salmonella infection is a common cause of vomiting. Vomiting caused by acute gastroenteritis is often accompanied by fever, headache, myalgia, abdominal pain, diarrhea, etc. In addition, nausea and vomiting are also precursor symptoms of acute viral hepatitis. Some viral infections can cause epidemic vomiting. The main clinical Features are: frequent frequent nausea and vomiting, which are more common in the morning, often accompanied by dizziness, headache, muscle soreness, sweating, etc. The disease recovers quickly, and vomiting usually stops in about 10 days, but it may recur after 3 weeks.

2. Nausea and vomiting caused by organ pain are reflexive vomiting, such as acute intestinal obstruction, bile duct stones, ureteral stones, intestinal torsion, ovarian cysts, etc., acute visceral inflammation (appendicitis, pancreatitis, cholecystitis, diverticulitis, peritonitis, Severe Crohn's disease, ulcerative colitis, etc.) are often accompanied by nausea and vomiting, and patients often have corresponding signs, such as abdominal muscle tension, tenderness, rebound pain, changes in bowel sounds, etc., laboratory tests showed elevated white blood cells, Some patients have elevated serum amylase (pancreatitis) or elevated bilirubin (cholelithiasis).

3. mechanical obstruction

(1) Pyloric obstruction: Acute pyloric duct or duodenal ampulla ulcer can cause pyloric congestion and edema, and sphincter spasm causes pyloric obstruction, which is manifested as nausea, vomiting, abdominal pain, and vomiting usually occurs 3 to 4 hours after eating. Abdominal pain after vomiting Relief. After antiulcer treatment and diet control, the symptoms of nausea and vomiting can disappear.

The pyloric obstruction caused by chronic duodenal ulcer scars manifests as a feeling of fullness in the upper abdomen after eating, delayed vomiting, large amounts of vomiting, sour odor, which can include overnight food, and an enlarged stomach type and peristaltic waves can be seen in the upper abdomen. Smell water.

Advanced tumors in the pyloric region of the gastric antrum can also cause pyloric obstruction, manifested as nausea and vomiting, loss of appetite, anemia, weight loss, fatigue, and epigastric pain.

(2) Duodenal compression or stenosis: Duodenal stenosis is caused by duodenal cancer, Crohn's disease, intestinal tuberculosis, and other diseases that cause extra-luminal compression include pancreatic head, pancreatic cancer, and mesentery. Upper arterial compression syndrome. This type of vomiting is characterized by delayed vomiting after meals, accompanied by fullness and discomfort in the upper abdomen, and sometimes with spasmodic pain in the upper abdomen. The vomiting often contains bile. Abdominal symptoms are quickly relieved after vomiting, and the mesentery The upper arterial compression syndrome mostly occurs in patients with recent weight loss, bedridden, lordosis, and vomiting disappears in the forward or thorax position. Gastrointestinal radiography shows a vertical sharp truncation on the right side of the midline of the duodenum. Stomach and proximal duodenum are dilated, and patients sometimes require loosening or short-circuit surgery.

(3) Intestinal obstruction: Intestinal tumors, tuberculosis, Crohn's disease, etc., or extra-intestinal adhesion compression can cause intestinal emptying disorders, leading to intestinal obstruction, often manifested as abdominal pain, abdominal distension, nausea and vomiting, and anus stop defecation Exhaustion and repeated episodes of vomiting are more severe. Early vomiting is food, gastric juice or bile. After that, the vomiting is brown or light green, and in the late stage is fecal-like, with a foul odor. Abdominal pain after vomiting is often not significantly reduced. Intestinal type can be seen after inspection. , Tenderness is obvious, palpable mass, hyperactive bowel sound, combined with abdominal X-ray plain film and other examinations can make a diagnosis.

4. Endocrine or metabolic diseases Many endocrine diseases can appear nausea and vomiting, such as gastroparesis, connective tissue disease hyperthyroidism crisis, hypothyroidism, pituitary adrenal kidney crisis, diabetic acidosis, etc. Nausea and vomiting are a minority of thyroid The main symptoms of early hyperthyroidism patients, hyponatremia can cause nausea and vomiting reflexively. In addition, nausea and vomiting often occur in the early stages of uremia, accompanied by digestive symptoms such as loss of appetite, hiccups, and diarrhea. According to various diseases Clinical features and auxiliary examination can clarify the cause of nausea and vomiting.

5. Drug-induced vomiting Drugs are one of the most common causes of nausea and vomiting. On the one hand, drugs and / or their metabolites can stimulate CTZ receptors (such as dopamine receptors), thereby generating impulses and transmitting them to vomiting. The center causes nausea and vomiting, such as chemotherapy drugs, narcotics, digitalis, etc .; on the other hand, it can stimulate the gastrointestinal tract, excite gastrointestinal nerves, and send impulses into the vomiting center, causing vomiting center excitement and nausea. Vomiting, such as some chemotherapy drugs, non-steroidal anti-inflammatory drugs and certain antibiotics.

6. Central nervous system diseases Cerebrovascular disease, cervical spondylosis and increased intracranial pressure caused by various causes can cause nausea and vomiting.

(1) Cerebrovascular disease: common diseases include migraine and insufficient blood supply to the vertebrobasilar artery. Migraine may be related to vascular movement disorders caused by vasoactive substances such as serotonin and bradykinin. Common causes include emotional excitement, insomnia, and alcohol consumption. And excessive smoking, the main clinical manifestations are paroxysmal unilateral headache, vomiting is usually spray-like, vomiting stomach contents, headache can be relieved after vomiting, accompanied by pale, cold sweats, visual changes and drowsiness and other symptoms, application The ergot derivative preparation can quickly relieve symptoms, nausea and vomiting due to insufficient blood supply to the vertebral-basal artery, and dizziness, visual impairment, ataxia, headache, and disturbance of consciousness.

(2) Increased intracranial pressure: rupture or obstruction of cerebral blood vessels, central nervous system infections (such as acute encephalitis, meningitis) and intracranial tumors can cause increased intracranial pressure and vomiting, which is characterized by often no nausea or vomiting before vomiting Slight nausea, vomiting is spouting and has nothing to do with diet. The vomit is mostly gastric contents, often accompanied by severe headache and varying degrees of consciousness. The headache is not significantly reduced after vomiting. Cerebrovascular accidents often occur with severe headache, vomiting, and disturbance of consciousness. , Hemiplegia, etc. In addition to headache and vomiting, patients with intracranial infection are also accompanied by chills, fever, and severe cases may have shock; vomiting of brain tumors often occurs when the headache is severe, and the headache can be temporarily reduced after vomiting, often accompanied by differences Symptoms of degree of neurological damage.

7. Vomiting during pregnancy Nausea and vomiting is one of the most common clinical manifestations during pregnancy. 50% to 90% of pregnant women have nausea, and 25% to 55% of pregnant women have vomiting. Nausea and vomiting often occur in the early stages of pregnancy. It disappears after the week, and vomiting is more common in the morning on an empty stomach. It is often induced by sleep disturbances, fatigue, and emotional excitement. If a pregnant woman is pregnant for the first time, pregnancy vomiting is more likely to occur. Pregnancy vomiting generally does not cause water and electrolyte balance or nutritional disorders. It also does not endanger the safety and health of pregnant women and fetuses; about 3.5% of pregnant women with severe vomiting can cause severe water-electrolyte disturbances and ketoacidosis. Pregnancy with severe vomiting is more likely to occur in multiple pregnancies, hydatidiform moles, and young but mentally ill In stable women, the mechanism of pregnancy-induced vomiting is unclear, and may be related to endocrine and mental factors.

8. Mental vomiting. Mental vomiting is common in young women, and has obvious psychological and psychological disorders, including neurovomiting, anorexia nervosa and polyphagia, vomiting episodes and mental stress, anxiety or mental stimulation are closely related, vomiting. It usually occurs at the beginning or end of eating, without nausea, effortless vomiting, not much vomiting, often food or mucus, and eating after vomiting. Patients can self-control or induce vomiting, except for anorexia nervosa because of fear or Refusal to eat can cause extreme weight loss and malnutrition. Outside of amenorrhea, many patients with neurogenic vomiting generally have normal appetite and nutritional status, and sometimes patients even eat more to cause excess nutrition.

9. Vestibular diseases of the inner ear Nausea and vomiting caused by vestibular diseases of the inner ear are characterized by sudden onset of vomiting, more severe, sometimes jet-like, and often accompanied by dizziness, headache, tinnitus, and hearing loss. Common diseases include motion sickness, labyrinthitis, and plum Meniere's disease and so on.

(1) Motion sickness: the main clinical manifestations are dizziness, nausea and vomiting, etc., nausea is often more obvious, vomiting often occurs after dizziness, mostly spray-like, with upper abdominal discomfort, cold sweats, pale, drooling, etc., halo The mechanism of ADHD is unclear. It may be caused by the stimulation of the vestibular part of the inner ear and the excitement of vomiting.

(2) Labyrinthitis: It is a common complication of acute and chronic otitis media. In addition to nausea and vomiting, the main clinical manifestations are accompanied by paroxysmal vertigo and nystagmus.

(3) Meniere's disease: the most prominent clinical manifestations are paroxysmal vertigo, accompanied by nausea and vomiting, tinnitus, deafness, nystagmus, etc. Vomiting often occurs after dizziness, and can be spray-like, with nausea, and vertigo after vomiting No significant reduction.

Nausea and vomiting test

Laboratory inspection:

It mainly includes laboratory tests related to inflammation, endocrine metabolism, and disorders of water, salt and electrolyte metabolism.

Other auxiliary checks:

Can be used for B-ultrasound, gastroscopy, ERCP, endoscopic ultrasound, CT, magnetic resonance and other special examinations.

Nausea and vomiting complications

No related information

Nausea and Vomiting Prognosis

No related information

Pathogenesis of nausea and vomiting

Nausea is a kind of mental activity of the human body. Various factors can cause nausea, such as internal organ pain, intracranial hypertension, labyrinth stimulation, and some mental factors. When nausea occurs, gastric motility weakens or disappears, and emptying is delayed. The tension of the duodenum and proximal jejunum increases, and reverse motility occurs, causing the duodenal contents to flow back into the stomach. Nausea is often a prelude to vomiting.

Vomiting is a complex pathophysiological reflex. The reflection path includes:

1. Information transmission by autonomic nerve conduction (of which vagal nerve fibers play a greater role than sympathetic nerve fibers).

2. Vomiting reflex center Two areas of the central nervous system are currently thought to be closely related to vomiting reflex. One is the medullary vomiting center, and the other is the chemical trigger zone (CTZ).

3. Efferent nerves, including the vagus, sympathetic, somatic, and cerebral nerves.

Vomiting caused by impulses from splanchnic nerve endings is usually called reflex vomiting, and vomiting caused by CTZ stimulation is called central vomiting. The medullary vomiting center is located on the dorsal and lateral side of the medullary reticular structure and near the vagus nucleus. It mainly receives afferent impulses from the digestive tract and visceral nerves, cerebral cortex, vestibular organs, optic nerves, nociceptors and CTZ. The chemosensory triggering zone (CTZ) is located in the posterior pole region at the bottom of the fourth ventricle. It is a bilateral region with dense dopamine receptors. Dopamine receptors play an important role in vomiting mediated by CTZ, because dopamine receptor agonists such as apomorphine, levodopa, and bromocriptine can cause vomiting, while its antagonist, metoclopramide (stomach Fu An), Modin and other drugs have antiemetic effects. Neurotransmitters such as serotonin, norepinephrine, neuropeptide substances, and r-aminobutyric acid in the chemoreceptor trigger region may also participate in the process of vomiting reflex. CTZ mainly receives vomiting stimulus signals from the chemical, pharmaceutical and other aspects of the blood circulation, and emits nerve impulses that cause vomiting reactions. However, CTZ itself can not directly cause vomiting, and the medulla oblongata vomiting center must be intact and mediated in order to cause vomiting, but the relationship between the two is unknown. CTZ is located outside the blood-cerebrospinal fluid barrier, and many drugs or metabolic disorders can act on CTZ. Certain drugs such as narcotics, chemical drugs, ergot derivatives, syringa syrup, etc. and certain peptide substances in the body such as thyroid hormone releasing hormone, substance P, angiotensin, gastrin, vasopressin, vascular intestinal peptide, etc. Both can act on CTZ and cause nausea and vomiting. In addition, nausea and vomiting caused by certain diseases such as uremia, hypoxemia, ketoacidosis, radiation sickness, and motion sickness are also related to CTZ.

The efferent nerve transmits the vomiting signal to each effecting organ, causing the process of nausea and vomiting. At the beginning of vomiting, the pylorus is closed, and the stomach contents cannot be discharged to the duodenum. At the same time, the cardia opening is relaxed, the cardia rises, the abdominal muscles, diaphragm muscles, and intercostal muscles contract, and the intragastric and intraabdominal pressures increase.